Health care providers told Democratic gubernatorial candidate Rob Sand on Wednesday that issues like Iowa’s privatized Medicaid system and restrictions on abortion are furthering problems in delivering and accessing health care in rural areas.
Sand’s campaign hosted a roundtable on rural health care in Newton with eight individuals from Iowa’s health care system throughout the state who spoke about the problems they face in fields like mental and maternal health care in rural Iowa.
Concerns about future access to health care outside of metropolitan areas have risen in recent months as Republicans in Congress passed the “One Big Beautiful” budget reconciliation bill that contained an estimated cut of more than $1 trillion from Medicaid.
In Newton, protesters and advocates have said the Newton Clinic and MercyOne Newton Medical Center could be at risk of closure due to the Medicaid cuts included in the “One Big Beautiful Bill Act” signed into law in July.
These concerns come as many rural Iowa health care providers have already had to close their doors or decrease services due to financial constraints. The Newton hospital paused all labor and delivery services in 2024. Dr. Abby Flannagan, an OB-GYN at UnityPoint Health in Grinnell, said at the roundtable the Grinnell hospital is now the only location many pregnant Iowans can go to to deliver their baby.
Flannagan said when she began at the Grinnell hospital over three years ago, her unit was delivering roughly 120 children each year, but that this year, her team will deliver 360 babies.
“And that’s still only three of us doing it,” Flannagan said. “So that’s the problem, is it’s we keep getting busier and busier and busier, and we’re asking (but) the help is just simply not there.”
Providers call for expansion of medical residencies, student loan forgiveness programs
Participants in the roundtable said one important step in addressing rural health care shortages — especially in maternal health care — was to increase residency slots. Flannagan said there are people going to school in Iowa or willing to move to receive training on obstetrics and gynecology care in the state, but said changes are needed to the state’s medical residency and loan forgiveness systems to support these medical professionals.
“It’s not that we don’t have people that don’t want to do this job, because there (are), it’s we don’t have residency spots, we don’t have anybody to train them, we don’t have any way to pay for it,” Flannagan said.
Gov. Kim Reynolds signed into law a measure earlier in 2025 that directed the Iowa Department of Health and Human Services to work to draw down $150 million in federal funding that would go toward creating a projected 115 new residency slots at Iowa teaching hospitals.
Sand did not comment directly on the 2025 law on expanding medical residencies, but said he would support changes like allowing people who move to Iowa to participate in loan forgiveness programs even if they did not sign up to participate in these programs while in medical school.
Six-week abortion ban impacts maternal health care access, roundtable participants say
The state’s six-week abortion ban was also brought up as a factor that makes providing maternal health care more difficult in Iowa. Aastha Chandra, a current medical student at the University of Iowa, said state lawmakers passing measures like the abortion ban and other laws restricting reproductive health care have caused some of her peers to reconsider continuing their education in Iowa, or choosing to practice in the state.
Chandra said a lot of Iowa medical students would be happy to stay here. “It’s great what we have here for a program at Iowa. Just, parts of our training just can’t happen anymore because of state law,” she said. “And that’s why so many people won’t train in states like Iowa with very restrictive abortion bans — because that’s part of our training, is to provide abortion care.”
Karin Mills, a mental health provider in Newton specializing in postpartum mental health, said many of her patients have post-traumatic stress disorder or related mental health struggles in part caused by difficulties they face during labor. If health care providers are not able to perform early intervention or make certain decisions when facing a pregnancy with complications, the result could mean unneeded trauma for the parent and child — or could lead to injury or death.
Mills shared her own experience with pregnancy, saying she believed “I would be dead” if she had been pregnant under Iowa’s abortion law. She said she was expecting twins when her doctor told her she was at severe risk of a stroke unless she delivered her babies early. She said she did not want to move forward with the process because the likelihood of survival for one of her twins was low.
After discussing the issue with her husband and doctor, she chose to go through with early delivery. One of the twins died after six days of care, while her daughter survived. “I can’t imagine having to have made that decision with the government telling you what to do,” Mills said.
She said this care could have been delayed if an abortion ban was in place, potentially putting her at higher risk of a stroke, and endangering the lives of both of her children and herself.
“Just think about the long-term fallout if I had a stroke – I wouldn’t be doing this job (as a mental health counselor),” Mills said. “… That time in (the) workforce and in my daughter’s life — and all the amazing things I’m sure she’s going to do in her life, odds are she would not be here. But that again, that blows my mind, to make a decision like that … forcing someone to continue to be pregnant, knowing that it’s harming all of the above.”
Sand also said other laws passed by Republicans in Iowa — like measures related to LGBTQ+ individuals — are also having an impact on the state’s health care system. He said speaking with Flannagan at the event helped him reflect on the importance of making sure Iowa is a “welcoming state,” and encourage more people like Flannagan and her wife to choose to practice medicine in Iowa.
“I think at the end of the day, the vast majority of Iowans want someone there to deliver their babies,” Sand said. “We were talking here to a female doctor who talked about her wife. And so, who do we want to have in Iowa? My answer is everybody. Because at the end of the day, if we only have three doctors between Iowa City and Des Moines on the east and west, and Waterloo and Pella on the north and south, I think our priority is having people there to deliver babies — which is part of the reason why I think it’s important we not just talk about being a welcoming Iowa, but actually quit with the culture wars and just be focused on actually solving real problems for people.”
